Provider Demographics
NPI:1760483432
Name:SCHWARTZ, DANIEL L (PA-C)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:L
Last Name:SCHWARTZ
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 602362
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2362
Mailing Address - Country:US
Mailing Address - Phone:336-765-2500
Mailing Address - Fax:336-765-2555
Practice Address - Street 1:694 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-3117
Practice Address - Country:US
Practice Address - Phone:336-719-7892
Practice Address - Fax:336-719-6870
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101918363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC101918OtherLICENSE NUMBER
NC2744894FMedicare PIN
S04451Medicare UPIN